Many interesting points have been made.

Local experience suggests that so far:-

Co-op workload is not obviously affected in either direction.
Telephone calls to casualty for advice are reduced.
Some calls are "second guessing" advice already given by a primary care
service.

Costs:-
Financial for running service and extensive advertising;
Manpower - nurses have been sucked out of face to face clinical work, incl
practice nurses;
GP advisory time.

Extensive evaluative data is apparently held but we are led to believe it
cannot be shared with those of us on the advisory group because of a DoH
embargo.

>Peter said:-

>The evidence so far from the 3 pilot sites, and from Europe and USA, is
that the people who need selfcare >are removed from the OOH system by
triage, appropriate patients go to GPs, A&E etc, etc, the people who
>only rang for advice but have serious illness get much better care and
overall outcomes are improved. With >the benefits in care to all NHS-D will
be hard to fault on clinical grounds alone.

Peter, where have you seen this evidence from the UK pilot sites.  This is
exactly the kind of information which we cannot get hold of and the kind of
"conclusion" I would expect to hear promulgated.  However in the absence of
raw data from NHS Direct or corroborative data from our co-op of which I
was the founding chair and am still a director I remain curious rather than
convinced.

While a service is being provided we have no evidence of it being
cost-benefit effective.

Replies suggest many of you expect this to be a local service so that there
would be an opportunity for it to be co-op based.  This is a possibility
but I am not aware that this is certain or even likely.  As it appears at
the moment I think it is more likely that each call centre will handle a
larger area, maybe a county or two, though potentially a few call handling
centres could provide NHS Direct for the whole country.  The technology
would allow answers to be customised depending on where the caller was
located.

Aside from the questions I asked earlier the sad thing about such an
arrangement is that putting the triaging software into co-ops would be a
valuable form of education and help to provide further support for on-site
nurses within co-ops.

Finally it has been suggested on the one hand that co-ops cannot employ the
staff or run NHS Direct themselves because they are not NHS bodies (a
political decision).  Yet I believe the same author who told us this
pointed out "The Goverment .... can change/bend/alter the rules as it wills
if needed to meet its ends."

Ahmad said: "I am deeply concerned about the mechanisms that decide who and
what can set up as an NHS-D provider."

Ahmad as ever is right.  Patients could get multiple benefits from NHS
Direct run by co-ops and the NHS would not need to waste money on
advertising. Locally this is in the form of leaflets to every household,
newspaper ads and radio advertising.  A cash strapped NHS?

I wish every success to those of you in co-ops which are bidding for a
slice of the action in the second wave pilots.  If you are widely
successful it would do much to lessen GP concerns.  I very much hope that
you won't find your time and precious managerial effort wasted because of
behind the scenes political decisions about the way in which this project
is to be developed.

NHS Direct is a potentially useful concept but £20M - £50M pa of public
money is involved.  Both GPC and GP academics have called for proper
evaluation before this project is significantly widened. Why is there even
one doctor on the list who supports anything else?

JB



%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%